1.1 	A bill for an act
1.2 	relating to insurance; requiring health plan companies to submit medical claims 
1.3 	data to health plan sponsors; proposing coding for new law in Minnesota 
1.4 	Statutes, chapter 62J.
1.5 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 	Section 1. [62J.84] MEDICAL CLAIMS DATA.
1.7 		Subdivision 1.Transparency. On an annual basis, health plan companies and 
1.8 	managers of preferred provider networks must submit to plan sponsors the comprehensive 
1.9 	medical claims data submitted for reimbursement under the sponsor's health plan.
1.10 		Subd. 2.Definitions. For purposes of this section, the terms in this subdivision 
1.11 	have the meanings given.
1.12 	(a) "Comprehensive medical claims data" means participant-specific medical claims 
1.13 	information that is submitted to a health plan company or a preferred provider network 
1.14 	manager for reimbursement under a health plan. Comprehensive medical claims data 
1.15 	includes, but is not limited to, information related to plan participants and providers; 
1.16 	claims submitted for payment, including diagnostic codes; provider pricing of claims; and 
1.17 	reimbursement provided to the provider by the plan and the participant.
1.18 	(b) "Plan sponsor" means:
1.19 	(1) the employer, in the case of an employee benefit plan established or maintained 
1.20 	by a single employer;
1.21 	(2) the employee organization, in the case of a plan established or maintained by an 
1.22 	employee organization; or 
1.23 	(3) in the case of a plan established or maintained by two or more employers 
1.24 	or jointly by one or more employers and one or more employee organizations, the 
2.1 	association, committee, joint board of trustees, or other similar group of representatives of 
2.2 	the parties who establish or maintain the plan.
2.3 		Subd. 3.Electronic submission. Submission of the data required in subdivision 1 
2.4 	must be provided in an electronic format that is agreed to by the plan sponsor and the health 
2.5 	plan company or manager of the preferred provider network that is submitting the data.